Infant Nutrition

Question 1

What are the principles of infant nutrition?

Answer 1

1) Adequate nutrition required for promotion of normal growth and brain development and prevention of illness
2) First 2 years of life is a period of rapid growth - vulnerable to nutritional inadequacies
3) Nutrition during “first 1000 days of life” is crucial - including pregnancy (270 days)

Question 2

What is exclusive breastfeeding?

Answer 2

No food or drink (incl. water) except breast milk (with exceptions of vitamin/mineral supplements an medicines)

Question 3

What is weaning?

Answer 3

The process of expanding diet to include food and drinks other than breast milk or infant formula (introduction of solid foods)

Question 4

What is complementary feeding?

Answer 4

The process of giving foods and liquids in addition to breast milk (or infant formula) when these are no longer sufficient to meet the nutritional needs of infants

Question 5

For how long is exclusive breastfeeding recommended?

Answer 5

First 6 months (26 weeks)

Question 6

What is the only recommended alternative to breastfeeding in infants < 12 months?

Answer 6

Infant formula

Question 7

When can nutritionally adequate and safe complementary foods be introduced alongside continued breastfeeding/infant formula?

Answer 7

6 (4) months - to meet their evolving nutritional requirements

Question 8

When should weaning start?

Answer 8

• Should not introduce solids before 4 months but no later than 6 months (child wants to eat and is excited in this window)
• Official recommendation is 6 months but this may be too late for some infants to commence weaning (after this may be v difficult)
• Most UK mothers start weaning before 6 months

Question 9

What are 5 infant nutrition recommendations other than breastfeeding?

Answer 9

1) Don’t use follow on formula before 6 months
2) No cow’s milk until > 12 months, whole milk until at least 2 years
3) If receiving < 500ml infant formula/day give vitamin A, C and D supplements from 6 months
4) Breastfeeding mothers should take 10μg/d of vitamin D supplement (not if using infant formula)
5) Do not add salt to food

Question 10

What is the nutritional composition of breast milk?

Answer 10

• Optimal nutrition composition to meet nutritional requirement if mother not deficient
• BUT low in vitamin D so breastfeeding mothers should take 10μg/d of vitamin D
• Iron concentration is low but bioavailability/absorption of iron in breastmilk is high

Question 11

How does breastmilk confer immunological protection (not in formula)?

Answer 11

• Contains bioactive factors
• Cellular factors - macrophages, neutrophils, lymphocytes
• Humoral factors - immunoglobulins (IgA, IgG), lysozymes, lactoferrin, bifidus factor, complement, interferon
• Particularly high concentrations in colostrum (initial milk)

Question 12

How does the composition of breast milk vary?

Answer 12

1) During the feed e.g. “foremilk” (thicker) and “hindmilk” (more watery at end)
2) With the stage of lactation - colostrum (‘first milk’) vs mature milk (4-5 months) is v different
3) Maternal diet e.g. fat composition or watery
4) Morning vs night

Question 13

What are the benefits of breastfeeding?

Answer 13

1) Optimal nutritional composition for human infant - provides all nutrients required for first ~6 months
2) Immunological protection and anti-infective properties
3) Bonding - due to early, prolonged physical contact
4) Convenience
5) Safety - sterile, no risk of incorrect preparation
6) Cost
7) Short and long term health benefits for baby
8) Health benefits for mother

Question 14

What are the short term health benefits of breastfeeding for the baby?

Answer 14

1) Protected against GI and respiratory infections
2) Decreased risk of otitis media
3) Decreased incidence of food allergy in pre-disposed

Question 15

What are the long term health benefits of breastfeeding for the baby?

Answer 15

• Decreased prevalence in overweight/obesity and T2D
• Decreased BP
• Increased performance in intelligence tests

Question 16

What are the health benefits of breastfeeding for the mother?

Answer 16

• Decreased risk of breast and ovarian cancer
• Uses ~500kcal/day
• Delays return of menstrutation

Question 17

Why is there less chance of getting pregnant while breastfeeding?

Answer 17

Because it delays the return of menstruation

Question 18

What are positive influences that encourage the decision to breastfeed/successful breastfeeding?

Answer 18

1) Early skin-to-skin contact following birth (ideally within 1h)
2) Early initiation first breastfeed (ideally within 1h)
3) Extra support by trained professionals

Question 19

What are negative influences that discourage the decision to breastfeed/successful breastfeeding?

Answer 19

1) Painful/mastitis
2) Baby has difficulty latching or not sucking - feel that milk supply is insufficient or the baby is ‘too hungry’
3) Medical difficulties
4) Lack of support/guidance from HCP and family
5) Provision of formula and/or other drinks while in hospital
6) Too much demand on mother’s time
7) Embarrassment
8) Living in a community where breastfeeding is not the norm
9) Incompatibility with work

Question 20

What is mastitis?

Answer 20

• When one of the milk ducts gets blocked leading to infection, swelling and bleeding
• Best to try and feed through the pain as it will eventually go away

Question 21

What medical difficulties can make breastfeeding more difficult?

Answer 21

1) C-section delivery
2) Preterm baby
3) Tongue tie of baby

Question 22

What is infant formula and how is it different from breast milk?

Answer 22

• Attempt to mimic human breast milk composition, nutritionally complete, safe substitute
• Expensive (not free)
• Usually made from industrially modified cow’s milk or soy products
• Lacks non-nutritional bioactive components of breast milk i.e. immune factors
• Has a different quantity and quality of macronutrients bc based on cows milk
• Basically all the same bc of guidelines on composition

Question 23

What are reasons for weaning?

Answer 23

1) Nutritional - energy and nutrient requirements exceed capacity that can be delivered by milk alone e.g. Fe stores low by 6 months
2) Development - ability to bite, chew, oral muscle development, speech development - encourage by variety of tastes and textures from 6-7 months

Question 24

What are the recommendations for weaning?

Answer 24

1) Introduce food around 6 months - but depends on individual infant and subject to much debate
2) Should be no earlier than 4 months (17 weeks)

Question 25

What are three signs of readiness for solid foods?

Answer 25

1) Can stay in a sitting position and hold their head steady
2) Can co-ordinate eyes, hands and mouth so that they can look at food, pick it up and put it in their mouth by themselves
3) Can swallow food - babies who are not ready will push food back out

Question 26

What should be the progression of solid foods?

Answer 26

1) Choice of ‘first foods’ ideally rich in Fe e.g. Fe-fortified infant cereal e.g. baby rice
2) Suitable early foods e.g. pureed/mashed veg, fruits, meats, fish, poultry, tofu, legumes, lentils
3) Important to progress in textures
- 6-9 months - puree to mash to mash + soft lumps
- 9-12 months - minced —> chopped
4) Finger foods to encourage self-feeding - baby-led weaning (they help themselves)
- Soft finger foods (~6-9 months) e.g. boiled veg, soft/ripe fruit
- Hard finger foods (~9-12 months) e.g. toast, bread sticks